Make the Diagnosis: Malignant or Benign?

Presentation

Case Findings: This otherwise healthy 55 year old man was sent to see his dentist because his primary care doctor noticed this new spot in his mouth. He is not sure how long it has been present.

What is your diagnosis?

2475% Melanoma

2276% Venous lake

1014% Amalgam tattoo

724% Argyria

Learnings

Amalgam tattoos are a common macular pigmentation caused by pieces of amalgam (silver filling material) accidentally implanted into the mucosa. It is asymptomatic.

What To Look For:
Look for a solitary, discrete, slate-gray or blue-black macule that is usually less than 1 cm in size. Sometimes lesions may be diffuse and poorly-defined. Although the gingiva, alveolar ridge mucosa, and buccal mucosa are common sites, it can occur anywhere. It may also be seen near a surgical scar after apical surgery to re-treat a tooth that has failed conventional root canal therapy.

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